Health Care Your Solution?

This is a discussion on Health Care Your Solution? within the Off Topic & Humor Discussion forums, part of the The Back Porch category; Originally Posted by Geezer
Put a cap on the amount that can be awarded in malpractice lawsuits. That would (possibly) reduce the ins preminums that ...

Do you really want a cap?

Originally Posted by Geezer

Put a cap on the amount that can be awarded in malpractice lawsuits. That would (possibly) reduce the ins preminums that the doctors/hospitals have to recoup from their patients. And for pete's sake, stop treating those useless illegal aliens.

Do you really want a cap? I knew a guy who got the wrong surgery and wound up paralyzed. As it turned out he refused to sue his doc because they had been life - long friends. He'd have prevailed. His son in-law is one of the big-shot attorneys you see on tv once or twice a week.

But, caring for a paralyzed person for a decade or two or more costs big bucks. Are you so sure you want a cap on awards?

What about really aggravated mistakes where the doc was stoned or drunk? What about instances where there was gross negligence?

Just asking for the sake of provoking some thought. 250K caps won't do it I don't think, and a no-fault system won't really solve the problem, though it might
be something of an improvement.

This is why we need a drastic increase in the number of physicians being produced, a great increase in the number of nurse-practitioners and physician's assistant's licensed.

What the free market does have to contribute is price reduction from competition. What we have now is inusfficient numbers of practitioners to provide for true competition.

I think I can agree with this part of your statement. But again, the question is "WHY?" aren't doctors and nurses getting in? Because the system isn't friendly to them with all the insurance requirements and a person has to spend how long in school with how much debt? There needs to be profit motive for a person to be willing to become a doctor.

"Run for your life from the man who tells you that money is evil. That sentence is the leper's bell of an approaching looter. So long as men live together on earth and need means to deal with one another-their only substitute, if they abandon money, is the muzzle of a gun."

For tinkerin

(added later: at least on my screen it looks like Pack and Patti jumped in before me. Your first post appears above mine, but I don't think I saw it when I hit the submit button.)

I think I can agree with this part of your statement. But again, the question is "WHY?" aren't doctors and nurses getting in? Because the system isn't friendly to them with all the insurance requirements and a person has to spend how long in school with how much debt? There needs to be profit motive for a person to be willing to become a doctor.

My opinion only, but I think the doctor shortage has nothing whatsoever to do with no ability to make money in the field. The shortage is manufactured by the very very very limited number of seats available in the medical colleges. We simply don't produce enough physicians to affect the supply in a significant way. Even with letting in a bazillion foreign trained docs (not good for keeping quality up) we continue to have shortages. The problem isn't finding people to go into the field, it is lack of capacity to produce sufficient number of docs.

With nursing, there is a different dynamic. There is some capacity shortage, but mostly it is a difficult, arduous, and often lousy way to make a living. Professional nurses catch crap from docs, patients, administrator. They are overworked often, and not appreciated.
We import huge numbers of nurses from other countries too, and this doesn't help quality of care either.

I'm not being xenophobic with my comments about foreign trained docs and nurses. I'm just of the opinion that our schools do a better job. I also think that it is hard enough to communicate about health issues with people who are native speakers of our language. Stuff gets lost when the person across the desk or the bed is silently translating into their own language and back.

Last edited by Hopyard; August 5th, 2009 at 07:07 PM.
Reason: to add an explanation

My opinion only, but I think the doctor shortage has nothing whatsoever to do with no ability to make money in the field. The shortage is manufactured by the very very very limited number of seats available in the medical colleges. We simply don't produce enough physicians to affect the supply in a significant way. Even with letting in a bazillion foreign trained docs (not good for keeping quality up) we continue to have shortages. The problem isn't finding people to go into the field, it is lack of capacity to produce sufficient number of docs.

Interesting theory - I haven't the foggiest idea but it sounds plausable

With nursing, there is a different dynamic. There is some capacity shortage, but mostly it is a difficult, arduous, and often lousy way to make a living. Professional nurses catch crap from docs, patients, administrator. They are overworked often, and not appreciated.
We import huge numbers of nurses from other countries too, and this doesn't help quality of care either.

I dated a nurse a few years back. Suddenly I'm drawing a blank on the proper scientific name for the department but she dealt with folks struggling with cancer and administering chemo. She was emotionally drained all the time and saw a lot of people die. The nurses get a lot closer to people than a doctor that sees them for 30 minutes once a month.

"Run for your life from the man who tells you that money is evil. That sentence is the leper's bell of an approaching looter. So long as men live together on earth and need means to deal with one another-their only substitute, if they abandon money, is the muzzle of a gun."

for tinkerin --"oncology?"

Originally Posted by tinkerinWstuff

I dated a nurse a few years back. Suddenly I'm drawing a blank on the proper scientific name for the department

I think you mean "oncology."

but she dealt with folks struggling with cancer and administering chemo. She was emotionally drained all the time and saw a lot of people die. The nurses get a lot closer to people than a doctor that sees them for 30 minutes once a month.

When I was still a kid I was a "messenger" at a very very large hospital. My job was to transport patients from their rooms to x-ray, or to specialized labs, or to the place where they did radiation oncology to treat cancer.

They kept most of their cancer patients on one particular floor. Going there to get folks for their radiotherapy was a very very difficult thing to do. You would have patients comment that they were going to do something a few weeks in the future, maybe go home, but you could tell by looking at them where the next stop was.

I've been in rooms with patients literally rotting (and stinking) from their cancers. I have no idea how the nurses do it. Bless them.

Well I thought off topic meant anything goes but thanks for takin a shot at me anyways. At any rate the expansion of the subject to other areas is a good thing because if we stay in our corners and don't communicate, we have only ourselves to blame when things go to hell in a handbasket.

Hop, In regards to increasing the number of doctors, wouldn't mass produced doctors result in a reduction of quality that you are concerned about? Everytime I have needed a doctor I have gotten to choose from several different ones.

Tort reform does not have to mean capping gross negligence, it simply means limiting frivolous lawsuits that people use to try and get rich off of some misfortune.

You are concerned about people that can't afford a couple hundred dollars worth let alone a couple thousand dollars worth of medical care. If you are so poor to afford minor medical care chances are that you are ALREADY covered under medicaid. How much does insurance cost for a $100 deductible? Compare that to a plan that has a $2500 deductible. I cannot afford insurance that has a $100 deductible and I doubt anyone that can afford that insurance is paying for it. All I know is that the govt. has yet to do anything well. I mean if the VA system is how they treat our heroes, then imagine what healthcare for the average joe is going to be.

Well I thought off topic meant anything goes but thanks for takin a shot at me anyways.

Not exactly - when you read the rules, I think from memory, it's #9, states no political topics. However, when political topics do creep in here, I have to admit they are more intesting because there is a wider diversity in opinions.

Originally Posted by obxned

If you want any sanity in the health care thing, force Congress and the president to live by what the rest of us have.

That seems to be the hot button talking point right now. The difference is that most politicians make enough money to buy whatever care they like. And the ammount of taxes they pay isn't nearly as prohibitive to their lifestyle. So, they will buy whatever care they like out of their pocket while the "rich" and middle class pays for the rest of america. BTW - the president will always get the best care your childrens money can buy. But x-presidents?? Again, the wealth factor sets them apart.

"Run for your life from the man who tells you that money is evil. That sentence is the leper's bell of an approaching looter. So long as men live together on earth and need means to deal with one another-their only substitute, if they abandon money, is the muzzle of a gun."

It was like that once upon a time. Even today, you can deduct the cost of your health insurance and your other medical expenses if you itemize and in total the costs exceed 7.5 % of your gross income.

So, this suggested change isn't really terribly different from what we already do. It would be nice if the threshold for deducting medical expenses were lowered, but we tried it that way and that didn't work either. So, its messed up either way.

Sounds good. But which prices will they post? Their highest? The Medicare reimbursement rates? The Blues' contract rates? Their best PPO rate? If you wanted to do this, the insurers would also have to give up their special reimbursement rates which the general public never knows. We see a bill for $3,500. The insurance company pays $750. To make this proposal work, and to get true price competition, would require some major changes in the way the insurance companies do business. Also, in many cases you have few choices about a single practitioner. There will be no price competition no matter what. Can you really shop prices in a crisis?

Sounds good until you realize that there a great many people who can't possibly afford a 2K deductible and will avoid getting treatment
when things are still minor problems instead of major expensive ones. Two hundred buck (which many won't have) to properly treat a bladder infection can quickly morph into thousand and thousands if the infection moves up into the kidneys. Do we really want people putting off care when the treatment is quick, easy, and inexpensive, only to have major calamities due to delays?

Tort reform will accomplish nothing. It has been tried extensively in a few states. Here, it is almost impossible to sue for malpractice. It has had no effect on prices, insurance premiums. Then also, it has been widely found that only 50% of all care meets the standard of care for the diagnosis. The docs are lucky government mostly keeps them out of court, because they too often do a pretty poor job. My wife was almost killed during a hospitalization because the nurses thought they had lab. results from blood drawn from my wife, and there was a mix up. If she was killed, or if she suffered a stroke, should I have been left without recourse? That is what tort reform will lead to. Do you (we) really want that?

1) Single payer; Medicare style for all. It actually works quite well.

2) Produce about 6 times the number of docs each year to drive the cost down by real competition. I just checked with the local state operated medical school on their budget. It cost 40 million each year to produce a little more than 100 docs. Surely we could operate our medical schools in a more efficient manner and greatly increase production of physicians.

3) Be realistic about not providing futile care that costs a bundle at the end of life. Before someone jumps on me about saving grandma, I can tell you it is only a matter of time before I will need dialysis or a kidney transplant. I intend when the time comes to seek hospice care. There's no point throwing money away trying to keep an old goat dropping beans on internet forums.

4) Increase the number of nurse practitioners who can handle very routine problems

One question about your number 3 above. We hear a lot lately about how expensive the last three months of life can be. Can you tell me when will YOUR last three months of life will be?

1.) The idea of a cap on awards is not needed. The true way to get rid of frivolous lawsuits is loser pays. If a lawyer has a lot of money on the line then he is not going to be as willing to take a frivolous lawsuit. Right now it is in their interest to bring as many suits as possible.

2.) Eliminate the tax deduction for businesses providing health care and switch it to a personal deduction (hell make it a credit). This will encourage insurance shopping instead of just going with the group plan.

3.) Advocating single payer and then complaining about # of medical personnel is hilarious. Look at all the single payer countries and inform me of which ones do not have worse doctor shortages than we do as well as worse quality of physicians. The reason this country has some of the best doctors is because the best from single payer countries realize they will actually be compensated for their skills in this country. just saying you need to increase the # of doctors doesn't make it happen. The best doctors are obviously going to be very intelligent and able to excel in another field if they are not getting paid enough in the medical field.

4.) The point about all the different prices is exactly the point of arguing about the need for itemized bills ahead of time. The medical organizations need to come up with a normal pricing system and charge what things really should cost to everyone. Part of the confusion has been created by medicare because the government is mandating what a procedure costs. So if it costs more, every other patient is saddled with the extra cost.

Liberals with MBAs and legal degrees seem to think they know more about running a convenience store than the man that ACTUALLY RUNS THE STORE. The Federal government cannot run any business better than the private sector. We cannot allow them to control 20% of our economy, because they only know how to run up deficits, and they will bankrupt this nation.

This hits it right on the head; a whole bunch of folks, including the one touting all of this, have never worked a real job or run any kind of business in their lives; they know nothing about accountability, profits versus losses or capital versus O&M expenditures. Just remember, this is the same bunch that couldn't even administer their own bank. When they closed that bank, the MB libs and others had written over 12,000 bad checks. We would all go to jail for something like that, and you really want these people to administer healthcare?? Come on......

Tort reform, this is KEY. Obama has no interest, in bed with trial lawyers

We have done this in Texas, and while it may not have had a dramatic effect on malpractice insurance, it has slowed the rise in costs a whole lot. I think, though there is a caveat here; I draw on my own experiences, one of my cousins had to have an emergency appendectomy a few years ago. Ordinarily this would have been routine had the emergency room doctor not been legally intoxicated and moved her to a room, then forgot about her for 12 hours. By the time they found her, the appendix burst, and she almost died. As luck would have it, the doctor had gotten off shift only an hour after he moved her to a room, then pulled out of the parking lot of the hospital and broadsided a vehicle traveling down the street. When police began questioning him they knew right off the bat he was drunk. What happened in the aftermath was that the attorney my cousin hired for his daughter got the hospital charges taken care of, as well as future complications associated with her condition, but more importantly the doctor had charges of medical malpractice filed against him and he eventually lost his license to practice and he spent some time in jail tacked on to his DWI conviction.

The reason I say this is because I feel to often that people equate justice with money. An insurance company pays out a huge settlement and the doctors and everybody move on and all is forgotten except the victims. Tort reform takes out the punitive damages that were killing the system. This forces families and individuals who truly seek justice to do so through the criminal justice system, which is where the punitive portion of medical malpractice should reside. Somebody should go to jail in other words.

As for the rest, I have a feeling this thread is gonna get long and heated, with some moderators thrown in for good measure..........So let the games begin

"Guard with jealous attention the public liberty. Suspect everyone who approaches that jewel. Unfortunately, nothing will preserve it but downright force. Whenever you give up that force, you are inevitably ruined". - Patrick Henry

1.) The idea of a cap on awards is not needed. The true way to get rid of frivolous lawsuits is loser pays. If a lawyer has a lot of money on the line then he is not going to be as willing to take a frivolous lawsuit. Right now it is in their interest to bring as many suits as possible.

I hear this point a lot. While it sounds good in a short paragraph, I have one huge concern that no one has been able to address.

While I believe the majority of business, big business, wants to do "the right thing." They want to do well and they want to obey the laws, you always have a few bad apples in the bunch. They think they are so large that their crap don't stink and they can buy off any lawsuit.

In today's system, the little guy can win. But if they are broke and fighting to get a big business to clean up their water supply on the farm what are the chances they are going to take on some huge corporation?

If someone can tell me how a loser pays system still allows for the broke little guy to have the same opportunity at justice then I'm all for it. Maybe the answer is finding a lawyer willing to take the case and the lawyer is on the hook as the "loser" should he lose the case.

"Run for your life from the man who tells you that money is evil. That sentence is the leper's bell of an approaching looter. So long as men live together on earth and need means to deal with one another-their only substitute, if they abandon money, is the muzzle of a gun."

1.) The idea of a cap on awards is not needed. The true way to get rid of frivolous lawsuits is loser pays. If a lawyer has a lot of money on the line then he is not going to be as willing to take a frivolous lawsuit. Right now it is in their interest to bring as many suits as possible.

That would make a difference in more than just the medical field. I actually like this solution better that capping punitive damages.

In regards to a "little guy can win" are you saying that enormous corporations don't out spend and out last the little guy? A loser pays system would not be terribly different than what the little guy goes through now. Usually the little guy hires a lawyer that does not get paid until victory and if they are victorious they give up a 1/3 of the settlement. Maybe the little guy could benefit by making the huge company pay for his lawyer.

I will jump in on this one since I am a self employed physician ( at least for now) so I have a pretty good view of some of the problems. I also work in a rural area which happens to be one of the poorest parts of the country. High unemployment right now too.

Regarding single payer, we have the prototype in medicare and medicaid. Since 65% of my income in medicare and my parents are and were on it, I have a pretty good view from both sides. First of all, it works. If you are a patient, it's pretty good insurance. If you need something, you'll probably get it. There are limitations on length of stay and some other things, but private insurance is like that too. If you are a doctor, you submit the bill, they deny, you submit again, they pay. Private insurance is like that too. Not a whole lot of difference there.

Except that you don't get paid much and that's actually the biggest problem for us. Reimbursement rates aren't that good. Medicaid, is worse which is why I don't take out of state medicaid. I am near three other states and I get a lot of patients from them and I could be swamped with out of state medicaid and go out of business fast since I subsidize each patient I see. I have only dropped one insurance plan because they were costing me money to take care of the patients! I don't mind taking care of a certain number of patients for free, especially if they are local and part of our community.

There are certainly problems with the way medicare is run and they are underfunded, but thats more a problem with how they collect money to fund themselves more than just bad management. They are also ripe for fraud and there have been some high profile cases lately.

By the way, no physician is getting rich of medicaid, we are not the reason the costs are so high. However, hospital reimbursements are high, and very close to what they are billing. I wish I could get that.

Most but not all private insurance companies reimburse as a percentage of medicare, say 124% to 135%. It doesn't matter if I bill for $1,000 or $10,000, they still pay $500 or what ever. But, if my printed charge is $10,000 and everyone else is billing $7,000, I get black listed as too expensive. We all still get $500 though.

I do believe that there should be some form of basic catastrophic universal health care that covers every man woman and child citizen or legal resident regardless of employment status. Right now, an uninsured person may not get care if they have cancer for example. Go through the ER for a trauma and you'll get covered, but if it's not an immediate threat to your life, you may not get it. So, we already irrationally ration health care.

However, I think there is nothing wrong with a two tier system. If you can afford it, get additional health coverage. Some people get to drive a mercedes some don't ( or is that a Wilson Combat?). That still supports a free market and choice.

Apparently, Switzerland has a mandate that all citizens be insured, it is not done through work, and all of the insurance is private. I believe they have vouchers or tax credits. Granted, they are a much smaller country, but it's something to think about as well. I really don't think that insurance should be tied to work. And it really ticks me off that my policy costs more than my ( hypothetical) twin brother's that he gets through a major corporation just because I have to buy my own.